Bringing down barriers to children's healthy eating: a critical review of opportunities, within a complex food system.

This narrative review revises the scientific evidence of recent years on healthy eating in children and adolescents, making sense of promising avenues of action, from a food system perspective. A conceptual framework is provided to better understand how eating habits of children and adolescents are shaped to identify key multisectoral approaches that should be implemented to promote healthier diets. The following influencing factors are discussed: individual factors (physiological and psychological factors, food preferences and food literacy competencies), factors within the personal and socio-cultural food environments, external food environments, and the supply chain. In each section, the main barriers to healthy eating are briefly discussed focussing on how to overcome them. Finally, a discussion with recommendations of actions is provided, anchored in scientific knowledge, and transferable to the general public, industry, and policymakers. We highlight that multidisciplinary approaches are not enough, a systems approach, with a truly holistic view, is needed. Apart from introducing systemic changes, a variety of interventions can be implemented at different levels to foster healthier diets in children through fostering healthier and more sustainable food environments, facilitating pleasurable sensory experiences, increasing their food literacy, and enhancing their agency by empowering them to make better food related decisions. Acknowledging children as unique individuals is required, through interpersonal interactions, as well as their role in their environments. Actions should aim to enable children and adolescents as active participants within sustainable food systems, to support healthier dietary behaviours that can be sustained throughout life, impacting health at a societal level.

Where is the father? Challenges and solutions to the inclusion of fathers in child feeding and nutrition research.

Despite an increasing acknowledgement of fathers' involvement in and impact on children's lives, fathers remain underrepresented in child feeding and childhood obesity prevention research, interventions, and actions. Built on our own experiences with conducting research with fathers and recent evidence on this topic, this Research in Practice article has three aims. It will first substantiate the importance of including and studying fathers in the field of child feeding and childhood obesity prevention based on recent study results. Secondly, the article will present and discuss barriers to fathers' inclusion and participation (why isn't it happening?), among other issues, by drawing on sociological and gender ideological insights. Finally, it will provide recommendations and suggestions related to recruitment, focus and methods that can facilitate fathers' involvement in future research, interventions, and practice. Taken together, this article aims to provide tools for giving fathers a voice in the field of child nutrition and by doing so, to decrease maternal-only "burden" of care. We hope our experiences and theoretical reflections will inspire and support researchers and practitioners to be as successful as possible in the realm of family care.

Spicing up food interactions: Development of a healthy food education activity targeting fathers and their young children.

BACKGROUND: Childhood obesity rates have been rapidly increasing worldwide. Several actions to reduce this trend have addressed maternal feeding practices. However, research reports an unwillingness to taste healthful foods expressed by children and fathers, which represents a major obstacle to a healthy diet in the family household. The present study aims to propose and qualitatively evaluate an intervention to increase fathers' involvement with their families' healthy eating through exposure to new/disliked healthy foods. METHODS: Fifteen Danish families took part in a 4-week online intervention involving picture book reading, a sensory experience session and the cooking of four recipes with four targeted vegetables (celeriac, Brussels sprouts, spinach and kale) and two spices (turmeric and ginger). Interviews were conducted with the families and the content was analysed through a blended or abductive approach. RESULTS: Participating in the activities motivated children and fathers to try new vegetables and spices, and increased fathers' sense of self-efficacy toward cooking, tasting new foods and healthy feeding. For the family, the intervention acted as a trigger to consume a higher variety of vegetables and spices and prompted feelings of "food joy". The outcomes observed are of importance considering the relatively low cost and the remote approach of the intervention. CONCLUSIONS: The results highlight the fact that fathers play an important role in the home food environment. We conclude that fathers should be included to a higher extent in food and nutrition strategies aimed at promoting healthy weight development in their children.

Exploring Barriers to Healthy Eating Among Women in Their Role as New Mothers with a Theory-Driven Questionnaire.

OBJECTIVES: This study aims to propose and evaluate a theory-driven questionnaire addressing barriers to healthy eating among mothers of young children. METHODS: Statements drawing upon the Social Cognitive Theory were developed/gathered based on literature review and previous qualitative research. Part I (43 items) included general barriers, attitudes to nutrition advice and outcome expectations. Part II (9 items) included subjective knowledge and general self-efficacy scales. An online survey was undertaken with 267 Danish women. The validation process included content and face validity, exploratory factor analysis (EFA) and reliability analysis. Confirmatory factor analysis (CFA) tested possible associations between the constructs and potential health outcomes (BMI and healthiness of eating habits). RESULTS: The EFA supported an adequate factorial validity with a 5-factor, 37-item structure model for Part I, and a high internal reliability of Parts I and II (Cronbach's alpha > 0.7). The CFA revealed an association between certain constructs and perceived healthiness of eating and BMI. Results support the reliability and factorial validity of the social cognitive measures assessing barriers to healthy eating among mothers. CONCLUSIONS FOR PRACTICE: These promising findings of reliability and initial validity suggest that researchers and practitioners interested in identifying women who face difficulties in the family food environment may find the scales useful. We propose a short version of the questionnaire for health practitioners.

Parenthood as a Window of Opportunity for Dietary Changes: Perspectives From Uruguayan Parents.

Research on behavioral and social science has demonstrated that transitions throughout a person's life course, as the life event of becoming a parent, represent an opportunity for dietary changes. However, research in this area has been mostly restricted to developed European and North American countries and has shown ambiguous results. The present work aimed to gain an in-depth understanding on the changes in eating habits caused by the transition to parenthood and to explore factors influencing those changes in Uruguay, a Latin American country. Forty-two in-depth interviews with Uruguayan parents from diverse social-economic backgrounds were conducted. The narrations by the interviewees evidenced mostly positive changes during three stages in the transition: pregnancy, the first months with the baby, and the beginning of complementary feeding. Most informants perceived changes mainly in terms of increased consumption of fruits, vegetables, and pulses; increased consumption of homemade meals; and decreased consumption of ultra-processed foods, fast foods, and fried foods. Reasons for these changes included adaptation of meals to the child's needs and schedule, feeling of responsibility for the child's health, and willingness to be a good role model. Factors influencing changes in eating habits were identified in some levels of the socioecological model and included socioeconomic status; price of fruits, vegetables, and fish; low accessibility of good quality fish; perceived time pressure; father's low interest on healthy eating; social support; and access to nutrition information. Findings suggest that parenthood represents a window of opportunity for favorable changes in eating habits. However, barriers constraining those changes should be addressed by stakeholders.

Socio-cognitive barriers to healthy eating among mothers: A segmentation analysis in Argentina, France, and Denmark.

The prevalence of childhood obesity has increased at an alarming rate despite several actions to reverse this trend. It is important to focus on tackling the constraints for healthy food provisioning. We focus on identifying segments of mothers in relation to factors acting as barriers to healthy eating. Five hundred mothers in each country (Argentina, France and Denmark) completed an online survey. In each of the three countries, four segments are identified, varying mostly on working and socio-economic status, self-efficacy and attitudes to health experts. Segments of mothers who are skeptical to nutrition advice from health professionals were identified. Another important finding is that staying-at-home mothers might face more barriers to healthy eating than mothers who work outside the home. We provide suggestions for targeted interventions addressing healthy eating behaviors among mothers with different profiles.

Adverse childhood experiences and delinquent behaviour: Predictors and mediating variables

ABSTRACT Background: Adverse childhood experiences (ACEs) have been identified as a risk factor for the development of mental health and behavioural outcomes throughout life, including delinquent behaviours. This article focuses on the relationship between ACEs and delinquent behaviour (DB), seeking to identify predictors and mediating variables. Methods: The quantitative study comprised 175 Portuguese adolescents, aged 12 and 17 years of age (M = 14.99, SD = 2.26). Results: ACEs and exposure to traumatic events (ETE) are predictive of DB. Antisocial traits (AT) was found to be mediating the relationship between ACEs and DB, as well as the relation between ETE and DB. Conclusion: The results indicate that it is necessary that professionals in health behaviour field prevent and intervene in ACEs and in ETE, both predictors of DB. The results of this study allow to understand the role of ACEs in DB and its mediating variables, which must be considered to mitigate the harmful impact of ACEs in DB.

Perspectives on sugar consumption expressed on social media by French-speaking and Danish-speaking parents.

INTRODUCTION: Meanings and practices attributed to sugar emerged as important barriers to healthy eating in an earlier study with French and Danish parents. Considering the impact of excessive sugar intake on human health and childhood obesity, this study focuses on gaining further understanding of connotations, perceptions and attitudes related to sugar among parents. METHODS: A thematic analysis of sugar-related posts and comments on blogs and Facebook pages was performed, and in-depth interviews with experts (one in each country) were conducted. Data were set in a Social Judgment Theory analytical framework. RESULTS: Sugar consumption appears as a two-sided experience, being at times dangerous, sinful and addictive, but also comforting and delightful. This "sugar dilemma" unfolded aspects between asceticism and hedonism, state governance and personal responsibility. Three main behavioral strategies on how parents deal with these ambivalences emerged: i) restriction, ii) moderation, and iii) liberation. Restriction was more noticeable in France, whereas liberation was more pronounced in Denmark. In both countries, the ones who defended the respective opposite positions (restriction or liberation) were targets of judgmental moral tones. The three behavioral strategies corresponded to the main attitudes demonstrated in reaction to anti-sugar messages, which align to the Social Judgment Theory constructs: acceptance, non-commitment and rejection. CONCLUSIONS: Findings shed light on dietary, behavioral and social challenges faced by parents and highlight the importance of a diversified approach to tackle sugar consumption among families - an approach that considers individuals' attitudes, social context and value systems. Furthermore, online sugar-related content yields valuable information on the social construction and morality of health and nutrition discourses and the misleading, confusing and overwhelming nature of social media content. Parents' discussions are an example of the general dilemmas between (gendered) parenting expectations, individual freedom and morality of food choices.

Necrotizing Fasciitis Causing Acute Compartment Syndrome after Radial Artery Catheterization.

Necrotizing fasciitis is a rare but potentially fatal infection involving the subcutaneous tissue and fascia with the development of necrosis of these structures. Acute compartment syndrome occurs when increased pressure within a closed muscle compartment compromises the circulation and function of the tissues within that space. We report the case of a male patient who was admitted to the intensive care unit for the management of urosepsis due to an acute obstructive pyelonephritis complicated by cardiopulmonary arrest. A radial arterial catheter in the left arm was urgently inserted, under suboptimal aseptic technique. His clinical condition progressively deteriorated, and swelling of the left arm with extension to the forearm with incipient signs of compromised perfusion were observed. The diagnosis of necrotizing fasciitis with acute compartment syndrome was made and an emergency fasciectomy performed. Following this, the patient gradually improved, organ dysfunction resolved, and he was discharged without sequelae. LEARNING POINTS: Necrotizing fasciitis is a rare but potentially fatal infection that can cause substantial tissue destruction and lead to sepsis.In rare cases, it can cause acute compartment syndrome, which occurs when increased pressure within a closed muscle compartment compromises the circulation and function of the tissues within that space.Both necrotizing fasciitis and acute compartment syndrome can be a complication of an arterial catheterization performed under suboptimal aseptic technique; hence, rigorous daily physical examination of the site is crucial for timely diagnosis.

A downturn or a window of opportunity? How Danish and French parents perceive changes in healthy eating in the transition to parenthood.

Alarming childhood obesity rates call for research into the factors that influence a child's environment. Although parents have a large influence on children's eating behaviours, surprisingly little research has explored parental healthy eating patterns. We conducted face-to-face interviews with parents of young children (up to 4 years old) living in Denmark (n = 16) and in France (n = 14) to provide insights into how the transition to parenthood affects the perceived healthfulness of eating behaviours. A problem-centred, Life-Course approach was employed, exploring the topics of interest from the perspective of the participants, and then interpreting these on the background of Social Cognitive Theory. From a cross-cultural sample of mostly well-educated parents living in couples, we found that the transition to parenthood represents a turning point for eating behaviour. Marked differences in dietary changes were perceived across four stages: 1) pregnancy, 2) first months with the baby, 3) complementary feeding and 4) child shares family meals. The findings point to an opposite cross-country perception of the impact of parenthood on food behaviours, and to the idea of what we called an "equalizing effect" on individuals' diet, where having a child triggered "unhealthy" eaters to consider dietary improvements while it imposed challenges to "healthy" eaters to maintain their satisfactory food habits. Contrasting differences on perceived behaviour change mainly appeared in terms of food ethics concern, meat consumption, cooking enjoyment, dietary diversity and sugar consumption. The proposition that low food-health-oriented individuals become healthier and (some) more environmentally conscious, reveals an opportunity for effective strategies and public health messages targeting health and food-ethics behaviour. Nevertheless, findings point to a need to consider individualized health support, addressing parental self-care, physiological changes, stress and negative emotions of early parenthood.

Health Behaviors as a Mediator of the Association Between Interpersonal Relationships and Physical Health in a Workplace Context.

The etiology of diseases is multifactorial, involving genetic, environmental, and lifestyle-related behaviors. Considering the pathway that involves behavioral processes, a huge body of empirical evidence has shown that some healthy behaviors such as non-smoking, any or moderate alcohol consumption, a healthy diet, (e.g., fruit and vegetable intake), and physical activity, decrease the risk of disease and mortality. This study aimed to explore the potential mediating effect of combined health behaviors on the association between interpersonal relationships and physical health in a Brazilian adult worker population from the Occupational Health Service within the oil industry in Bahia, Brazil. The sample included 611 workers, of which 567 (92.8%) were males and 44 (7.2%) females, age ranging from 18 to 73 years (M = 41.95; SD = 8.88). The significant predictors of physical health were interpersonal relationships and health behaviors. Health behaviors contributed significantly to a reduction in the effect of interpersonal relationships on physical health outcomes. As far as it is known, there has been no prior work in Brazil that simultaneously examined the best predictors of physical health in oil workers using this conceptual model. Interventions in the workplace environment need to consider health behavior as a mediator between interpersonal relationships and physical health, aligned in a global psychosocial approach to health at work.

Psychological well-being and health perception: predictors for past, present and future

Abstract Background Increasing evidence supports an association between psychological well-being and overall health, however, much remains to be understood about this association. The current study addresses this issue by presenting a new perspective focusing on health perceptions. Additionally, it examines the impact of each of six dimensions of psychological well-being on health perception. Methods Data for this study were collected from a sample of 1,155 Portuguese adults in various settings. Findings reveal that psychological well-being dimensions' impact differently on prior, current, and health outlookperceptions. Furthermore, the dimension depressed mood influences current health perception; in turn, current health perception is the strongest predictor for psychological well-being. Our results provide support for a bidirectional relationship between health perception and psychological well-being.

Uma proposta de medida da qualidade dos recursos humanos em turismo / A proposal to measure the quality of human resources in tourism / Una propuesta de medida de la calidad de los recursos humanos en turismo

Estudo empírico sobre a validação da subescala "Recursos Humanos em Turismo", adaptado à realidade portuguesa, que visa avaliar a perceção dos decisores públicos locais sobre esta dimensão da qualidade. O estudo integra 134 participantes, provenientes de 125 municípios portugueses, tendo-se extraído 5 fatores responsáveis por 64.21% da variância total, designadamente: Competências profissionais, Política de emprego, Estratégia de negócio, Acesso à formação e Mercado de trabalho. Competências pessoais, conhecimento especializado, domínio de línguas e conhecimento aprofundado sobre a cultura e a especificidade da região na qual trabalham são os atributos mais valorizados pelos inquiridos, quanto às competências dos recursos humanos em turismo. Esta é uma situação à qual a tutela, as entidades de ensino e as empresas devem estar atentas, enquadrando nos seus planos estratégicos ou planos de estudos, temáticas direcionadas para a análise da identidade cultural dos destinos, contribuindo para a sua diferenciação.

An empirical study on validation of the "Human Resources in Tourism" subscale, within the scope of a more extensive project to validate a measurement instrument, adapted to the Portuguese reality, intended to evaluate the perception of local public decision makers on various dimensions of tourism quality, was conducted. The study included 134 participants from 125 Portuguese municipalities, with 5 factors accounting for 64.21% of the total variance, namely: Professional skills, Employment policy, Business strategy, Access to training, and Labor market. Personal skills, specialized knowledge, language skills. and in-depth knowledge of the culture and specifics of the region in which they work are the attributes the respondents value most, as the main competencies of human resources in tourism. This is a situation requiring the attention of government bodies, educational entities, and companies, framing in their strategic, academic, and training plans, themes directed at analyzing the cultural identity of destinations, contributing to their differentiation.

Estudio empírico sobre la validación de la sub-escala "Recursos Humanos en Turismo", adaptado a la realidad portuguesa, que busca evaluar la percepción de los responsables públicos locales sobre esta dimensión de la calidad. El estudio integra a 134 participantes, provenientes de 125 municipios portugueses, habiéndose extraído 5 factores responsables por el 64.21% de la varianza total, a saber: Competencias profesionales, Política de empleo, Estrategia de negocio, Acceso a la formación y Mercado de trabajo. Competencias personales, conocimiento especializado, dominio de lenguas y conocimiento en profundidad sobre la cultura y la especificidad de la región en la que trabajanson los atributos más valorados por los encuestados, en cuanto a las competencias de los recursos humanos en turismo. Esta es una situación a la que la tutela, las entidades de enseñanza y las empresas deben dar atención; encuadrando en sus planes estratégicos o planes de estudios, temáticas dirigidas al análisis de la identidad cultural de los destinos, contribuyendo a su diferenciación.

Efficacy indicators of four methods in outpatient addiction treatment

Abstract Background In Portugal, as far as we know, there are no recent studies that evaluated the comparative efficacy of therapeutic modalities in addiction problems by reference to a holistic and psychosocial model of effectiveness. Objectives Using a sample of Portuguese patients in outpatient treatment for drug and alcohol abuse, this study aimed to examine if a combined treatment modality (group therapy with individual intervention) had greater overall efficacy when compared to other three types of treatment without group therapy. Methods This is a correlational and cross-sectional study using a convenience sample of patients (N = 254) from an outpatient treatment in the Intervention Service on Addictive Behaviors and Substance Dependence. At the time of data collection, the patients were attending four types of treatment, such as receiving intervention based on individual psychological counseling (n = 66); receiving individual psychiatric counseling (n = 68); receiving both individual psychological and psychiatric counseling (n = 102); and receiving not only individual counseling (i.e., psychology or psychiatry), but also attending group therapy (n = 18). Results Using MANOVA and Wilks's multivariate test criterion, there was a significant effect of treatment modality on the global efficacy, Λ = 0.88, F(9, 603) = 3.75, p < 0.0001. Examination of mean estimates indicated that patients in a combined therapeutic modality revealed more treatment involvement compared to patients in other therapeutic modalities without group therapy. Discussion The results obtained in this study highlight the importance of integrating interventions in a collaborative way. A combined therapeutic modality, adding group therapy, was associated with positive effects, such as more levels of peer support and involvement in treatment, and increasing the individual's probability to remain abstinent.

A pessoa em fim de vida no serviço de urgência: abordagem terapêutica dos profissionais de saúde / The End-of-Life Patient in the Emergency Department: A Therapeutic Approach by Health Professionals

A sociedade atual, defende o que é belo, esconde o que é feio, acredita que a juventude é eterna e que podemos vencer a morte. Constata-se que falta lugar para a morte, para o luto e para tudo que envolva estados de dependência. Esta recusa da sociedade atual em aceitar a morte, "empurra" a pessoa que está a experienciar a última etapa da vida para o hospital, sendo a sua porta de entrada o serviço de urgência. O serviço de urgência assente numa perspetiva curativa, cuja missão consiste na prestação de cuidados de saúde dirigidos a situações de urgência e emergências médicas, confronta-se cada vez mais, com pessoas que se encontram em processos de fim de vida e que exigem dos profissionais de saúde mudanças na sua filosofia de cuidar, exigindo recetividade para a mudança/inovação das práticas clínicas. De facto, responder às múltiplas exigências da pessoa em fim de vida e família no serviço de urgência, transcende a lógica e o racionalismo, a solução encontra-se nos cuidados paliativos, cujo objetivo é oferecer cuidados ativos e organizados. Neste sentido, tendo como propósito contribuir para a humanização dos cuidados à Pessoa em fim de vida no serviço de urgência, colocamos a seguinte Questão de Investigação: Quais as abordagens terapêuticas priorizadas pelos Profissionais de Saúde, perante a Pessoa em fim de vida no Serviço de Urgência? com o Objetivo Geral: Conhecer as abordagens terapêuticas priorizadas pelos Profissionais de Saúde, perante a Pessoa em fim de vida no Serviço de Urgência. Metodologia: abordagem qualitativa, estudo exploratório-descritivo, utilizando a entrevista semiestruturada dirigida a enfermeiros e médicos a desenvolver funções num serviço de urgência de um hospital da região Norte de Portugal, para a recolha de dados. Utilizamos a análise de conteúdo segundo Bardin (2011), como procedimento para a análise dos dados. Os procedimentos ético-moral foram respeitados. Principais Resultados: verificamos que os participantes do estudo conceptualizam os cuidados paliativos, como cuidados que tem o objetivo de promover a qualidade de vida, o conforto, a relação, o controlo sintomático, a dignidade e o alívio do sofrimento. Imperando no serviço de urgência modelos de cuidados essencialmente biomédicos centrados na cura e ritmos de trabalho acelerados, constatou-se que a maioria dos participantes considera ser possível prestar cuidados paliativos no serviço de urgência, se existir uma aposta na formação, na sensibilização dos profissionais de saúde, maiores rácios humanos, melhores condições arquitetónicas e mais recursos materiais. Entendem como cuidados prioritários para a pessoa em fim de vida no serviço de urgência o alívio sintomático; medidas de conforto; companhia; comunicação com a família, privacidade e responder às necessidades efetivas daquela pessoa. Verificamos ainda, que existe uma variabilidade de motivos que conduz à adoção de estratégias terapêuticas de âmbito curativo, nomeadamente: a dificuldade em assumir e lidar com o processo de morrer e o défice de formação em cuidados paliativos. Preservar a dignidade da pessoa impõe abordagens que envolvam a dimensão não só biológica, como social, cultural, emocional, espiritual, bem como, a existência de espaços que permitam a privacidade e a existência de um trabalho em equipa de parceria. Conclusão: A filosofia e o modelo de organização do serviço de urgência, dificultam cuidar da multidimensionalidade da pessoa em fim de vida. Contudo os profissionais de saúde consideram que é necessário existir mudanças na forma de cuidar e que é possível prestar cuidados paliativos num serviço de urgência desde que se aposte na formação em cuidados paliativos e que o enfermeiro especialista em Médico-cirúrgica seja o assessor dos outros profissionais de saúde

Our society defends what is beautiful, hides what is ugly, believes youth is eternal and that we can beat death. Therefore, there is little room for death, for grieving and for everything that relates to dependency states. This refusal by our current society to accept death "pushes" people experiencing their last stage of life to the hospital, with the emergency department being their point of entry. The emergency service, based on a healing perspective, the mission of which consists in providing healthcare during emergency situations and medical emergencies, is increasingly confronted with people who are in end-of-life processes and who require healthcare professionals to change their philosophy of care, but they are not always prepared for this change/innovation in their clinical practices. In fact, answering to the multiple demands of people at the end of life and relatives in the emergency department transcends logic and rationalism and the solution may be found in palliative care, the objective of which is to provide active and organised care. In this sense, with the purpose of contributing for the humanisation of the care provided to the Person at the end of life in the emergency department, the following Research Question was asked: Which therapeutic approaches are prioritised by Healthcare Professionals dealing with the Person at the end of life in an emergency context? This had the General Goal of Becoming Familiar with the therapeutic approaches prioritised by Healthcare Professionals dealing with the Person at the end of life in an emergency context. Methodology: qualitative approach, exploratory-descriptive study, using a semi-structured interview directed to nurses and physicians working in the emergency department of a hospital in the northern region of Portugal, for the collection of data. Content analysis according to Bardin (2011) was used as a procedure for data analysis. Ethical-moral procedures have been respected. Main Results: it was observed that participants in this study conceptualise palliative care as having the objective of promoting quality of life, comfort, relationships, control of symptoms, dignity and relief of suffering. With essentially biomedical care models focused on healing and accelerated work rhythms, one found that the majority of participants considered it possible to provide palliative care in the emergency department, if there is a focus on training, awareness raising among health professionals, higher human capital ratios, better architectural conditions and more material resources. They understand as priority care to the person at the end of life in the emergency department symptomatic relief, comfort measures, company, communication with the family, privacy and answer to that person's effective needs. It was also verified that there are multiple reasons behind the adoption of healing therapeutic, particularly the difficulty in assuming and dealing with the process of dying and lack of training in palliative care. Preserving the person's dignity calls for approaches that encompass not only the biological dimension, but also social, cultural, emotional, and spiritual aspects, as well as the existence of spaces that allowed for privacy and the existence of a partnership team work. Conclusion: The philosophy and its organisation model hinder the provision of care for the multidimensional aspect of the person at the end of life. Healthcare professionals, nevertheless, consider it necessary to enforce changes in the way of caring and that it is possible to provide palliative care in an emergency department provided that there is a focus on training in palliative care and that the nurse specialising in Clinical Surgical Nursing is the advisor of other health professionals.

Community intervention: assessment of parental training of a family prevention programme of substance use and associated risk behaviours / Intervención comunitaria: evaluación de la formación de los padres de un programa de prevención familiar de consumo de sustancias y comportamientos de riesgo asociados

Abstract The manuscript presents the results of a family and community intervention project to prevent drug use. The project was theoretically based in two integrative models - Structural Model of Cowen and Eco-Developmental Model - taking a multicausal perspective and the methodological principle of empowerment. This study had two assessment moments: (T1) a week before the intervention and (T2) a week after the end of the intervention. Data was collected from 42 adults with parenting responsibilities and the results indicate significant changes in the increase of cohesion, expressivity, control, and the increase of the orientation for recreational activities. It has also observed a decrease of the educational strategies that characterise the authoritarian and permissive styles.

Resumen El manuscrito presenta los resultados de un proyecto familiar de intervención comunitaria de prevención del consumo de drogas. El proyecto se basa en dos modelos de integración: modelo estructural de Cowen y modelo ecodesarrollo, adoptando una perspectiva multicausal y guiándose por el principio metodológico de empoderamiento. Este estudio tuvo dos momentos de evaluación: (T1) una semana antes de la intervención y (T2) una semana después del final de la intervención. Se presentan los datos reunidos de 42 adultos con responsabilidades parentales y los resultados indican cambios significativos en el ámbito familiar en el aumento de la cohesión, expresividad, el control y de la orientación de las actividades recreativas. También se observa una disminución de las estrategias educativas que caracterizan los estilos autoritarios y permisivos.

The effectiveness of substance abuse treatment: development of a brief questionnaire

Practitioners need brief instruments to monitor outcomes in both treatment of drugs and alcohol addiction because they are useful to guide decision making in a short time. Objectives: This study aims to develop a brief questionnaire, based on Client Evaluation of Self and Treatment, to evaluate the treatment effectiveness in drug and alcohol addiction treatment settings. Methods: A cross-sectional study using a convenience sample (N = 608) recruited from Division for Intervention on Addictive Behaviours and Dependencies (DICAD – ARS North). Results: The results show a new four-factor solution that accounted for 54.4% of the total variance and that provides the best fit to the data (c2/df = 1.72, CFI = .94, GFI = .91, RMSEA = .048 [.040-.057]; prmsea = .623). It also revealed a high internal consistency (a = .82). It was found a significant negative correlation (r = - .52, p < .01) between the final version of the instrument and a self report measure of psychopathology symptoms. Discussion: This brief questionnaire, with good psychometric properties, can be useful to provide a viable and rapid feedback of treatment outcomes. Further studies should be performed to continue the evaluation of the reliability of this measure...